ePAD
Project title
Electronic castration-resistant Prostate cancer Australian Database
Investigators
Dr Ben Tran (Principal Investigator)
Sites
15 cancer centres across Australia
In the field of metastatic castration-resistant prostate cancer (mCRPC), multiple questions demand answers. There is now a great variety of systemic therapies available, but clinicians need to know which therapies are most effective, how to sequence the treatments and how to avoid and manage cross-resistance.
According to ePAD Principal Investigator, Dr Ben Tran, the most efficient way to answer these questions is through access to real world data, facilitated by BioGrid Australia.
BioGrid has helped with management, contracts with industry (specifically by bringing together three partners with different needs), database development and roll out to sites.
Patients with advanced prostate cancer in major centres across Australia are enrolled on the ePAD database prospectively. The aim is to enlist 650 patients over three years and to evaluate the impact of age, cardiovascular co-morbidity and performance status on treatment recommendations. ePAD will also map survival outcomes and investigate the role of novel hormonal therapies in changing tumour biology.
One research focus of the ePAD project is to examine the treatment of bone metastases in men with advanced prostate cancer. Bone metastases develop in more than 90% of such cases and are a significant cause of morbidity and mortality, resulting in complications such as pain, pathological fractures and spinal cord compression.
Bone-modifying agents reduce the rate of skeletal complications, although no survival benefit from their use has been seen. As these agents were evaluated and approved before the introduction of hormonal therapies, there are differing opinions amongst clinicians and their use and scheduling across centres varies widely.
Leading this arm of the ePAD project is Dr Angelyn Anton. Dr Anton used the ePAD database to examine current Australian prescribing patterns for bone-modifying agents and found a low rate of usage overall. Further analysis of data showed that skeletal complications often occur early in patients, and few were receiving the agents when the first injury manifested. This research suggests that the agents should be considered earlier in treatment to prevent serious complications of bone metastases.
Use of bone-modifying agents in Australian men with castration-resistant prostate cancer (CPRC)
Our results demonstrate a low rate of BMA use in Australian men with CRPC and bone metastases. The dominant 6-weekly treatment schedule is likely based on convenience, given the absence of efficacy data.
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Examining skeletal-related events in Australian men with castration-resistant prostate cancer (CPRC)
In our ePAD analysis SREs often occurred early in the disease trajectory, prior to the initiation of systemic therapy for CPRC. Few patients were recieving BMAs at the time of the first SRE.
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ANZCTR information ID: ACTRN12616000585426
Dr Ben Tran
Medical Oncologist, Peter MacCallum Cancer Centre
Research Fellow, Walter Eliza Hall Institute of Medical Research